This document discusses a case of microsporidial keratitis in a 28-year-old female patient. It provides details of the patient's history and examination findings. Microsporidial keratitis is an infection of the cornea caused by the microsporidia organism, with symptoms of pain, watering, and blurred vision. The document discusses the characteristics, transmission, risk factors, treatment, and clinical findings of microsporidial keratitis. The patient was diagnosed with microsporidial keratitis in the left eye and prescribed topical medications for treatment.

1. Presented by :-
RAMJI PANDEY
consultant Optometrist
1

2. M#R: xxxxx
Name: yyyyy
Age: 28
Sex: Female
D/O: 9/2/1987
Occupation: House Wife
2
DEMOGRAPHIC DATA

3. Pain
watering
F.B sensation
Blurring of vision
Chief Complain
3

4. No H/O of ocular and head injury
No H/O of recent oph.consultant @ Bijnor with
Dr. Jay prakash
Past History
No H/O of using glasses
4

5. Family history :- Nil
Surgeries/lasers procedure/ Allergies/
Systemic disease/ Past surgeries / current
treatment:-Nil
current treatment: using some eye drops
5

6. UVA OD OS
Distance :- 20/20 20/40 20/30
Near :- N6 N12
with Hindi chart at 30 cm.
Retinoscopy (dry) :- plano plano
Acceptance Dist. :- DEFER
Near :-
IOP & time 12 Dig(N)
(mm of Hg @2:03pm)
6

7. External examination :- HBT :- Orthotropia
0 0 0 0 0 0
0 0 0 0
0 0 0 0 0 0
Slit Lamp Examination.
7
OD OS
Lid Flat flat
Conjunctiva Quiet Congestion
Cornea Clear As shown
Anterior chamber PACD>1/4CT/Quiet PACD>1/4CT/Quiet
Pupil R/R/R R/R/R
Lens
iop
Clear
12
Clear
DIG(N)

8. .
8

9. FUNDUS EXAMINATION (OU) WNL
C:D = (OU) 0.3 : 1 HNRR
DIAGNOSIS
(OD):-Emmetropia
(OS):-Microspordiosis keratitis
Treatment Adv:-
E/D moxixip Q2H
E/D R.L Q2H
Tablet Diclomol TID
9

10. Subject :- patient fells same as previous
UVA :-(OD):- 20/20
(OS):- 20/30 20/25p
SLE (OU) :- Ant. Seg (OD): WNL
(OS)
Cornea: as shown
Rest all ant seg: WNL
Follow op # 10 day
10
CRX
As adviced

11. .
IMP advice
Doing well CST
e/d Flarex QID

12. Microspordial keratitis
This infection of the cornea which is form an organism
known's as microspordia. Where 75% involment of the epithelia
and J25% of stromal layer
oseph J, Vemuganti GK, Sharma S. Microsporidia: Emerging Ocular Pathogens. Indian Journal of Medical Microbiology.
2005;23(2):80-91.. 12

13. Microspordia
 Species of protozoa
 Recent studies : related to kingdom fungi
 size 3.5*2 micron
 spore forming
 obligate intracellular parasite
 First recognized - 1857
 First reported – 1973 in India
13

14. The infectious pathogen causes
 ocular infection
 sinus
 hepatitis
 nephritis
 muscular disease
14

15. ocular microsporidiosis
 Kerato conjunctivitis
 kerato uveitis
 microspordial keratitis
15

16. .
16

17. Risk factors
 Dirty water
 Trauma
 Insects bites
 Contacts with domestic animal
 Immunodeficiency immunocompetent
 Exposure of hot spring season
 Topical steroid
 contact lens wearer
Vemuganti G, Garg P, Sharma S, Joseph J, Gopinathan U, Singh S. Is Microsporidial Keratitis an emerging cause of stromal
keratitis?- a case series study.BMC Ophthalmology.2005:5:19.
17

18. Systemic disease
 Immune suppressions disease
e.g. AIDS
Typhoid
Diabetes
18

19.  Currently, most cases of human Microsporidiosis are
associated with HIV infection.
* Weber R, Bryan RT. Microsporidial infections in immunodeficient and immunocompetent patients. Clin Infect
Dis.1994;19:517-21.
But recently Microsporidia has been reported to cause
multifocal coarse superficial punctate keratitis in
immunocompetent individuals.
* Joseph J, Sridhar MS, Murthy S, Sharma S. Clinical and microbiological profile of microsporidial keratoconjunctivitis
in Southern India.Ophthalmology.2006;113:531-7.
19

20. Epidemiology
 90 % UNILATERAL
 RACE: No predilection
 SEX: No predilection
 AGE: No predilection
 SEASON: Monsoon
1. Quek DT, Pan JCH, Krishnan PU, Zhao PS, Teoh SCB. Microsporidial Keratoconjunctivitis in the Trpics: A Case Series.
Open Ophthalmol J.2011;5:42-47.
2. Reddy AK, Balne PK, Garg P, Krishnaiah S. Is Microsporidial Keratitis a seasonal infection in India? Clin Microbiol and Inf.
2011 Jul; 17(7):1114-6
20

21. Clinical findings
 white dots on the cornea
 satellite opacities
 multiple superficial epithelial
infiltrate
 oval in shape opacities
 corneal sensation are normal
 fluorescence statining
21

22. 22

23. Transmission
 Human to Human
 Animal to Human
 Water transmission
 Inhalation
23

24. Ocular Symptoms
 Pain
 Watering
 Foreign body sensation
 Discharge
 Blurring of vision
24

25. Physical symptoms
 Watering from nose
 Headache
 Recurrent of fever
 Diarrhoea ( loose, watery , nonbloody)
 Muscular pain , muscles weakness
 Infection of the brain
 Weber R, Bryan RT. Microsporidial infections in immunodeficient and immunocompetent patients. Clin Infect
Dis.1994;19:517-21.
25

26. Investigation
26
Systemic investigation
1. urine
2. Intestinal tract
3. Nasal discharge

27. 4. AIDS
Ocular Investigation
1.corneal scraping
 Gram stain
 KOH Stain
 Acid Fast Stain 27

28. 28

29. Treatment
General treatment
 personal hygiene
 Change the environment
 Maintains balance diet
 Proper hygiene of contact lens
29

30. Medical therapy
 Antibiotics
 Anti fungal
 Anthelmintics
 Antiprotozoals
 Immunomodulatory
 Lubricating
 Treatment of the associated disease
30

31.  Treatment of Microsporidial Keratitis with Topical
Voriconazole Monotherapy
1. Khandelwal S, Woodward M, Hall T, Grossniklaus H, Stulting R. Treatment of Microsporidia Keratitis With Topical
Voriconazole Monotherapy. Arch Ophthalmol.2011 Apr; 129(4):509-510
31